| Primary Care At Home Llc | |
|
9526 S 86th East Ave Tulsa OK 74133-6415 | |
| (918) 346-3094 | |
| Not Available |
| Full Name | Primary Care At Home Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 9526 S 86th East Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Larry Montgomery (PRACTICE MANAGER) |
| Authorized Official Contact | 9183463094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care At Home Llc 9526 S 86th East Ave Tulsa OK 74133-6415 Ph: () - | Primary Care At Home Llc 9526 S 86th East Ave Tulsa OK 74133-6415 Ph: (918) 346-3094 |
| NPI Number | 1871148908 |
|---|---|
| Provider Enumeration Date | 08/06/2019 |
| Last Update Date | 08/06/2019 |
| Medicare PECOS PAC ID | 5193057024 |
|---|---|
| Medicare Enrollment ID | O20191028000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871148908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Julie Haberly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235783325 PECOS PAC ID: 0446582373 Enrollment ID: I20191028000072 |
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